| Course | HS820 Global and National Health and Health Systems |
|---|---|
| Unit | Unit 9 |
| Paper type | Country comparison paper |
| Length | About 1,150 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Health Science (DHSc) |
| Updated | October 2026 |
Free sample paper for HS820 Unit 9
When the Deadline Passes: A Unit 9 Comparison of Denmark's Free Choice and Portugal's Surgery Vouchers as Waiting-Time Guarantees
[Student Name]
Purdue University Global
HS820: Global and National Health and Health Systems
Unit 9 Country Comparison
[Instructor Name]
[Date]
The facts about both countries and the sources cited are real; figures are rounded and labeled as approximate.
The Question
A maximum waiting-time guarantee is only as strong as what happens when it is missed. A promise without a consequence changes little; a consequence that patients rarely use may still change hospital behavior through the threat of use. This paper asks how each country's guarantee changes what hospitals and patients do when a wait exceeds its limit, and what explains the difference.
Context
Both countries fund health care mainly from taxes and provide it largely through public hospitals. In Denmark, five regions, created in 2007, own and run hospitals and are funded mainly by the state. In Portugal, the National Health Service is run by the Ministry of Health through regional health administrations, with hospitals organized increasingly as public enterprises. Both faced long waits for elective surgery in the late 1990s and early 2000s and adopted guarantees in response (OECD, 2013). Comparative profiles place both among tax-funded systems in which a public provider network is expected to meet most demand, which is what makes a broken waiting promise a political as well as a clinical problem (Tikkanen et al., 2020).
Design of the Guarantee
Denmark. Extended free choice, introduced in 2002, gave patients the right to be treated at a private hospital or clinic in Denmark or abroad, paid for by their region, if the public system could not treat them within a set maximum. The limit was two months at first, later reduced to one month for many treatments. The patient triggers the exit by choosing to use the right, and the region pays the private provider at negotiated rates.
Portugal. The Integrated Management System for the Surgical Waiting List, known as SIGIC, began in 2004. Patients are registered on a central list, and when a patient's wait reaches a set share of the maximum guaranteed time, the system automatically issues a voucher that can be used at another public hospital or a contracted private or social sector hospital. The system triggers the exit, and the cost of the treatment is charged against the originating hospital.
The designs differ on three points. In Denmark the patient triggers the exit; in Portugal the system does. In Denmark the region pays; in Portugal the originating hospital bears the cost. And Portugal's central list makes every wait visible to managers, while Denmark's right depends on patients knowing and asserting it.
Portugal made the originating hospital pay for its own delay, while Denmark made the region pay, and that difference shaped how each hospital responded.
Uptake of the Exit Option
Denmark. Use of extended free choice rose after 2002, with a substantial and growing share of elective treatments performed in private facilities under the scheme, especially for orthopedic procedures. Uptake depended on patients knowing their rights and on the availability of private capacity, which expanded in response.
Portugal. Large numbers of vouchers were issued, but a substantial share were not used. Patients often declined to travel to another hospital, preferring to wait for their own. Even so, hospitals that faced losing revenue had an incentive to treat patients before the voucher stage.
Uptake is treated as a key outcome because a guarantee that is rarely used works only through its threat. In Portugal, low voucher use did not mean the guarantee failed: the cost to the originating hospital may have changed behavior before vouchers were issued.
Changes in Waiting Times
Both countries reported reductions in waiting times for elective surgery after their guarantees took effect. Comparisons of waiting times across OECD countries caution that countries measure waits differently: some count from the specialist's decision to treat, others from referral, and some report mean waits while others report medians (Siciliani et al., 2014). Denmark and Portugal do not measure waits identically, so the paper compares trends within each country rather than levels across them.
In Denmark, waits for many elective procedures fell after 2002, and the share of patients treated within the guarantee rose. In Portugal, median waits for surgery fell substantially after SIGIC, and the number of patients waiting beyond the maximum guaranteed time declined.
Explaining the Difference
Three structural features explain why each guarantee worked as it did.
First, private sector capacity. Denmark had a small private hospital sector that grew in response to free choice, giving patients somewhere to go. Portugal had private and social sector hospitals that could accept vouchers, but patients were reluctant to travel.
Second, the trigger. Portugal's automatic voucher meant the guarantee did not depend on patients knowing their rights, which may have made it more equitable. Denmark's patient-triggered right may have been used more by better-informed patients.
Third, who bears the cost. Charging the originating hospital in Portugal gave hospitals a direct incentive to reduce waits. In Denmark, regions bore the cost, which gave them an incentive to expand public capacity but placed less direct pressure on individual hospitals.
Confounders
Other factors also affected waiting times. Portugal's austerity years after 2011 reduced health budgets and may have lengthened waits in later years. Denmark's hospital reforms and increased funding for elective surgery in the 2000s also contributed to shorter waits. The paper therefore claims only that the guarantees contributed to reductions, not that they caused them alone.
What a U.S. Reader Can Take From the Pair
The United States has no national waiting-time guarantee, but the same design questions arise wherever a public payer promises timely access, as the Veterans Health Administration did when it allowed veterans facing long waits to use community providers. The Danish and Portuguese cases suggest that the questions to settle first are who triggers the exit, the patient or the system; who pays the outside provider, the facility that missed the deadline or a central budget; and whether outside providers have capacity to take patients. A program that leaves the trigger to patients and the cost to a central budget will tend to resemble Denmark's early experience, with uptake concentrated among informed patients and limited pressure on the facilities causing the delay.
Lessons
The comparison supports two conditional lessons. A guarantee works best when the consequence of missing it falls on the provider responsible for the delay, and when the system, not the patient, triggers the exit. And a guarantee depends on alternative capacity; without somewhere for patients to go, a right to go elsewhere is empty.
Limits
Waiting-time data are not directly comparable between the two countries, and the period covered includes economic shocks that affected both. A fuller study would use patient-level data to estimate the effect of each guarantee while controlling for funding changes.
References
OECD. (2013). Waiting time policies in the health sector: What works? OECD Publishing. https://doi.org/10.1787/9789264179080-en
Siciliani, L., Moran, V., & Borowitz, M. (2014). Measuring and comparing health care waiting times in OECD countries. Health Policy, 118(3), 292-303. https://doi.org/10.1016/j.healthpol.2014.08.011
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International health care system profiles. The Commonwealth Fund.
The Purdue Global HS820 Unit 9 instructions
The ninth unit generally asks for a paper comparing two countries on a single health system question. Expect about twelve pages organized by question, not by country. Pose one question that both countries must answer, then give brief context on each system. Run matched sections, applying the same sub-question to both countries in each. Match evidence by type, and say where definitions differ, since countries often measure waits, costs or outcomes in different ways. Describe policies mechanically: who acts, who pays and what happens to budgets. Explain differences through structure, and name economic shocks or other reforms as confounders. Limit conclusions to what matched evidence supports, and compare trends within countries when levels are not comparable.
Inside the HS820 Unit 9 example
The sample states its question and gives context on Denmark's five regions and Portugal's national service, citing the OECD's 2013 review and the Commonwealth Fund profiles. The design section sets out extended free choice and SIGIC, then three differences: patient versus system trigger, region versus hospital paying and visibility of the list. The highlighted sentence ties Portugal's charge to the originating hospital to how hospitals responded. Uptake sections show growing private treatment in Denmark and many unused vouchers in Portugal. A waiting-time section cites Siciliani and colleagues on measurement differences. Discussion, confounders, a section for U.S. readers drawing on veterans' community care, lessons and limits close the paper. Every section closes by stating what the pair shows on that question.
HS820 Unit 9 rubric: what earns full points
Country comparison papers in HS820 are typically marked on the comparative question, structure, matched evidence, explanation of differences, sources and writing. Structure and explanation weigh heaviest, with markers expecting sections that apply the same question to both countries and an argument about why outcomes differ. Evidence should be matched by type, with definitional differences acknowledged. Papers written as two separate country profiles lose marks, as do those claiming a policy caused a change without discussing confounders. Mechanical descriptions of policy, who acts and who pays, are often credited. A focused question earns more than broad coverage. Precise APA references and clear prose cover what remains.
HS820 Unit 9 help from the desk
A frequent slip is writing all of Denmark and then all of Portugal, so the comparison happens only in the reader's head. Others mix evidence types, setting one country's median wait against another's mean. Some ignore economic shocks or reforms that happened at the same time. Questions are sometimes too broad to answer in twelve pages. If your countries are different, perhaps England and Sweden or Canada and Australia, send the prompt and any required question, and we can build matched sections with comparable evidence and a structural explanation. Some papers also treat low uptake of an exit option as failure, when the threat of its use can change behavior. Say clearly what each national source measures before you set two figures side by side.
Get an HS820 Unit 9 example written to your instructions
One question, two systems: give the pairing and the question that the Unit 9 paper must answer, with the rubric and any required sources. The paper will hold the question to both countries in every section, match evidence by type, flag definitional mismatches, and argue structure against confounders. Delivery is 24-48h, and the first custom sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HS820 Unit 9 questions, answered
How do I choose the question for a country comparison?
Pick one both systems must answer and on which they differ in design, such as how they limit waits, pay physicians or control drug spending. The question should be narrow enough to answer with matched evidence. Broad questions about which system is better usually produce parallel profiles, which this kind of assignment is designed to discourage.
What if the two countries measure outcomes differently?
Say so, and compare trends within each country rather than levels across them. Waiting-time definitions differ, for example in when the clock starts. The sample describes each definition, compares changes over time within each system, and uses the OECD's harmonized reporting where it exists, noting where even that falls short, so a reader knows which comparisons rest on firm ground.
Is a rich-country pair acceptable if the course covers global health?
Usually, if the question justifies it. Denmark and Portugal are both tax-funded, so the pairing holds financing constant and lets guarantee design carry the comparison. Pairs involving low- or middle-income countries work well for questions about financing or coverage expansion. Check the prompt, since some sections require at least one system outside the high-income group so that transfer questions can be raised later.
Where can I find a free HS820 Unit 9 sample paper?
The full Unit 9 comparison is posted here, setting Denmark's free choice against Portugal's surgery vouchers question by question.
Why did unused Portuguese vouchers not mean the guarantee failed?
Because the originating hospital bore the cost of each voucher, so it had a reason to treat patients before the voucher stage, whether or not vouchers were used.